Week 11 Learning Outcomes

PNUR 124


Week 11: Diabetes

1. Discuss current issues, trends and research related to diabetes mellitus.
 What is Diabetes:
o Diabetes is “a multisystem disease related to abnormal insulin
production, impaired insulin utilization, or both” (Lewis et al. 2019, p.
1287).
o A common chronic endocrine disorder of impaired glucose regulation
that affects the function of all cells and tissues.
o There are different types (Type I, Type 2, Gestational Diabetes along with
other conditions resulting in hyperglycemia)
 Prediabetes
o Also known as impaired glucose tolerance (IGT) or impaired fasting
glucose (IGT)
o Occurs with fasting or 2-hr plasma glucose level higher than normal (6.1-
6.9 with IFG; 7.1-11 mmol/L for IGT)
o Increased prevalence in Canada (up to 6 million cases).
o 50% of individuals develop DM
o Often symptomatic
o Health promotion is critical; maintain healthy weight, exercising regularly,
healthy diet, medications as prescribed)
 Gestational Diabetes
o Develops during pregnancy
o Hyperglycemia can develop during pregnancy because of the secretion of
placental hormones, which causes insulin resistance.
o Detected between 24 and 28 weeks of gestation
o Occurs in about 3% of pregnancies in Non-indigenous population; 2-3 x
higher in Indigenous peoples.
o First line therapy = nutritional counselling, if ineffective may require
insulin therapy
o 10% progress to DM after pregnancy
 Secondary Diabetes
o DM can occur because of another medical condition (schizophrenia,
Cushing’s syndrome, hyperthyroidism, immunosuppressive therapy, TPN)
o Medication use (corticosteroids, Dilantin, atypical antipsychotics
(clozapine).
o Pancreatic diseases and hormonal abnormalities
 Risk Factors for Diabetes
o Family history of diabetes (i.e., parents or siblings with DM)
o Obesity (BMI> 25 kg/m2)
o Ethnicity (e.g., African descent, Latino, Asian Americans, Indigenous)
o Age (> 45 years)
o Hypertension (with BP > 140/90)

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o High cholesterol levels (LDL)
o History of gestational diabetes or delivery of babies over 9 pounds

2.
Differentiate
between
Type I
and
Type 2
diabetes
in terms
of
etiology
and




treatment
modalities.
 Type 1 Diabetes
o Also known as insulin dependent diabetes
o Associated with genetic disposition
o Involves beta-cell destruction leading to absolute insulin deficiency
o Is an autoimmune disorder
o Occurs in individuals who are < 30 yrs. (peak onset 11-13 yrs. old)
o Clinical Manifestations of T1
 Hyperglycemia (as there is no insulin to transport glucose into the
cells)
 Hyperosmolality (increase glucose in blood draws water from the
intracellular spaces in the vascular circulation)
 Polyuria
 Polydipsia
 Polyphagia
 Fatigue and malaise; weight loss
 Vaginal yeast infections
 Blurred vision (osmotic effects = swelling of lenses)
 DKA
 Type 2 Diabetes

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o Occurs due to decreased production of insulin by the pancreas
o Involves metabolic abnormalities (insulin resistance, metabolic syndrome
– abdominal obesity, HTN, Dyslipidemia)
o Occurs in individuals who are > 35 years, with up to 90% being obese at
time of diagnosis.
o Is the most prevalent type of diabetes
o High risk populations (Indigenous, Latin America, South Asian, and African
descent)
o No longer known as “adult onset” DM, now seen in children and
adolescents.
o Clinical Manifestations of T2
 Slow onset of manifestations
 Hyperglycemia
 Fatigue
 Polyuria and polydipsia can occur
 Weight loss
 Recurrent infections
 Prolonged wound healing
 Visual acuity changes
 Painful peripheral neuropathy in feet

3. Discuss best practices of self-care management of diabetes for maintaining blood
glucose levels through diet planning, sick day management, lifestyle choices and
exercise.
 The Role of Obesity
o Obesity reduces available insulin receptor sites, leading to insulin
resistance
o Central obesity, defined as waist circumference > 40 inches in men, and
>35 inches in women.
o Three-quarters of older adults wit type II are overweight
o All older adults develop insulin resistance
o Weight loss with diet and exercise can reduce insulin resistance
o With enough weight loss, the client may not need oral medications
 Complications of Diabetes
o Acute
 Diabetic Ketoacidosis (fats are broken down
due to lack of insulin; triad of
hyperglycemia, ketosis, metabolic acidosis,
and dehydration).
 Hyperosmolar hyperglycemic state (HHS)
 Hypoglycemia
 Hyperglycemia